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Reviewed by the Faculty of Harvard Medical School

Pregnancy After 35

If you're older than 35 and pregnant, you're in good company as more women are having children later in life.

A pregnancy after age 35 may require some special precautions, because it can be riskier than childbearing during the optimum years of ages 20 through 34. But advances in medical care have made it safer than ever before, and most women in their late 30s and 40s have healthy pregnancies and babies. Still, there are factors to keep in mind if you're considering a pregnancy after age 35:

Decreased Fertility

It may take you longer to become pregnant because there's a general decrease in fertility that begins in the early 30s. That's when women typically begin to ovulate less frequently, or are more susceptible to endometriosis, a condition in which tissue similar to that lining the uterus attaches to ovaries or fallopian tubes, which can make conception more difficult. Other problems may also accumulate with age, which may decrease the chance of conceiving. So if you're older than 35 and have been unable to conceive after six months, see your doctor or a fertility specialist because many of these "infertility" cases can be treated.

Greater Risk Of Miscarriage

Women older than 19 have lower rates of miscarriage, premature delivery and stillbirths than pregnant women in their teens — because the bodies of teen-age mothers are still developing and these mothers are more likely to live in socially and economically disadvantaged circumstances, use illegal drugs and alcohol during pregnancy, have poor nutrition, and have inadequate access to health care. But women older than 35 face higher rates of miscarriage than women younger than age 35, while women older than age 40 may face substantially higher rates of miscarriage as high as 40 percent. Most of these miscarriages are caused by chromosomal abnormalities, which are more common in women older than 35.

More Health Problems During Pregnancy

Women older than 35 are twice as likely as those in their 20s to develop high blood pressure or diabetes during pregnancy — conditions that could adversely affect the mother and fetus during pregnancy. They also face a higher risk of placental and bleeding problems during pregnancy. As women age, the incidence of medical problems not necessarily related to pregnancy but that can complicate pregnancy increases.

Harder Deliveries

First-time mothers older than age 30 typically have harder labor than younger women, including a prolonged second stage of labor and more fetal distress. Women aged 35 through 39 may have a 27.4 percent chance of delivering by Caesarean section and those aged 40 through 49 have a 31.6 percent chance, higher rates than those of younger women. They're also more likely to give birth to twins or triplets.

Greater Risk Of Genetic Disorders

One of the biggest concerns of an older pregnancy is a higher likelihood of having a child with certain genetic disorders. The most common problem is Down syndrome, a condition caused by the presence of an additional chromosome that is associated with mental retardation and other physical abnormalities.

At age 25, a pregnant woman has a 1 in 1,250 chance of delivering a Down syndrome baby; at age 30, it's 1 in 952; at age 35, 1 in 385; and at age 40, 1 in 106. Prenatal testing such as amniocentesis or chorionic villi sampling can detect genetic abnormalities such as Down syndrome early in the pregnancy. Recently, it has become common to have blood tests and a special ultrasound called a nuchal translucency screening during the first trimester to screen for abnormalities.

To ensure a healthy pregnancy, it's essential that older women follow these basic rules of pregnancy:

Get early and regular prenatal care, ideally starting before conception. Screenings for birth defects can be done through amniocentesis, ultrasound, chorionic villous sampling and maternal serum screening tests.

Eat healthy before and during pregnancy, and try to achieve proper weight for your height before you conceive. Your doctor will likely recommend a specific diet.

Take 400 micrograms (.4 milligrams) of folic acid each day. You'll get this amount in most multivitamin supplements. Once you are pregnant, the USRDA for folic acid increases to .8 milligrams. Besides supplements, foods rich in folic acid include romaine lettuce and other green, leafy vegetables; dried beans; oranges; and wheat germ.

Don't drink or smoke during pregnancy. And avoid using any drugs during pregnancy — including over-the-counter medications — unless your doctor says it's OK.

Last updated June 2, 2009




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